新生儿败血症早期临床诊断

Early diagnosis of neonatal septicemia

目的：探讨诊断新生儿败血症早期的临床首发症状及实验窒依据，以益早期诊治。方法：对我院新生儿科2001年1月～2004年12月收治的415例败血症患儿进行回顾性分析，分为足月儿组及早产儿组，分别对其发病时间、感染途径、临床首发症状及实验室检查等方面进行对比。结果：两组均以生后7日后发生率高；感染途径足月儿以皮肤、脐部为主，早产儿以呼吸道为主；临床表现上足月儿组首发症状依次为发热、纳少、皮肤黄疸、反应差。而早产儿组以体温波动、纳少、皮肤黄疸、腹胀及呼吸暂停为首发症状；早期的实验室检查以中性粒细胞与C反应蛋白（简称CRP）增高、血小板减少、以及血糖的变化对临床早期诊治较有意义。结论：新生儿临床败血症应注意早期反复发热或体温波动、纳少、皮肤黄疸、反应差等隐匿的中毒症状，并且结合入院周围血象、CRP、血糖及感染途径进行综合分析，对早期的诊治有指导意义。

Objective： To dicuss the early diagnosis of neonatal septicemia according to clinical symptom and laboratory evidence in pristine septicemia. Methods： The data of 461 neonatal septicemia from January 2001 to December 2004 in this hospital were analyzed retrospectively, which divided into two groups of term infant and premature sets, contrasting the difference in onset time, route of infection, clinical symptom and laboratory examination. Results： Onset time： two groups demonstrate that incidence of style （〉7 days） was higher. The mute of infection： the early symptoms of term infants were skin and pars umbilicalis infection; the pathogen ofter invaded from respiratory passage in premature group. Clinical symptom： the symptoms of term group by turns were fever, appetite decrease, jaundice, reaction dullness; the symptom of premature group were body temperature fluctuation, reaction dullness, appetite decrease, jaundice, abdominal distention, apnea. Laboratory examination： the increased heterophil granulocyte and CRP, decreased plate-reduction and blood glucose alleosis were significant for early diagnosis and treatment. Conclusion： The recurrent fever, appetite decrease, jaundice, reaetion dullness and other insidious toxic symptoms in early time and aggregate analyse with amph - hemogram, CRP, blood sluice and infection route should be analyzed comprehensively to play the guidance role in early diagnosis and treatment of neonatal septicemia.